As the second leading cause of death after heart disease, cancer remains one of our nation's most serious health problems. Cancer screening tests have been proven to be highly effective in detecting cancer at early stages, and are generally safe, convenient and inexpensive. Yet, available evidence suggests that ther is great variation in how well physicians actually use cancer screening tests. Little is known about why physicians fail to perform cancer screening or about ways to encourage them to use tests more often. This project will evaluate three strategies to promote physicians' use of cancer screening tests: 1) Medical audits combined with feedback to physicians; 2) Automated Health Maintenance Records and reminders to physicians; and 3) Patient education. These strategies were selected based on prior research indicating their potential to alter physician ordering practices. The study is a three-year randomized controlled trial to be conducted in a large university general medical practice with approximately 60 resident physicians as subjects. Over two years of the study, four successive cohorts of residents will be followed for two 9 month periods: 1) a pre-intervention period, during which baseline data about screening performance and knowledge will be collected; during the subsequent intervention, subjects will receive one, two, or no interventions; and 2) a post-intervention period, during which measurements of screening performance and knowledge will be repeated and compared. Targeted dependent variables will be seven screening tests recommended by the American Cancer Society (stool test for occult blood, rectal exam, sigmoidoscopy, Pap smear, pelvic exam, breast exam, mammogram). Other related non-targeted dependent test variables also are included. Data analysis will be analysis by variance and covariance. The long-term goal of this project is to increase the discovery of cancer at early, more treatable stages, thereby improving health outcomes. Specific steps toward this goal include: 1) assessment of the relative effectiveness of each of the three interventions in promoting the use of cancer screening; 2) evaluating the feasibility of implementing them in the clinical setting; 3) measuring the financial impact of the three strategies and their impact on direct costs and cancer detection rates; and 4) dissemination of findings to other hospitals and clinics to assist them in establishing their own cancer screening promotion programs.